The use of "Lactusan" in the department of viral hepatitis

Perm Children's City Infectious Disease Clinical Hospital N 5

V.E. BOBRIKOV, Chief Physician of the Perm Children's Clinical Hospital Candidate of Medical Sciences

On the use of Laktusan for dysbacteriosis in the department of viral hepatitis

The aim of our study was to determine the effectiveness of Lactusan monotherapy in intestinal dysbacteriosis at a dose of 5 ml in children under three years of age and at a dose of 10 ml over three years of age in a course of 2 weeks.

The effectiveness of the treatment was assessed by comparing the microbial landscape of the intestine before and after treatment. Bacteriological examination and assessment of the degree of dysbacteriosis were carried out in accordance with the guidelines of the Moscow Research Institute of Epidemiology and Microbiology. G.N. Gabrichevsky from 1986.

Under observation were 38 children with viral hepatitis and gastropathology aged: from 0 to 3 years — 5 children, from 4 to 7 — 10 children, from 8 to 11 years — 8 children, from 12 to 15 — 14 children.

Among the examined were 24 children with concomitant allergic diseases, including 8 with exacerbation of allergic dermatoses.

Before treatment, stage I dysbacteriosis was diagnosed in 11 patients, stage II dysbacteriosis in 13 patients, and stage III dysbacteriosis in 14 patients.

E. coli with hemolyzing properties (45%), citrobacter (20%), enterobacteria (20%), Klebsiella (15%), microbial associations (40%) were more often detected.

Examination after the course of treatment showed an improvement in biocenosis indicators in 22 patients (57.9%), including those with grade II and III dysbacteriosis, an increase in the level of bifidobacteria to 109 in 18 out of 27 (66%) patients, a decrease in seeding of opportunistic flora in 13 (48% ), in 1 child - the disappearance of pathogenic E - Coli O 144.

With dysbacteriosis of the I degree with a normal initial level of bifidobacteria, an improvement in the biocenosis was registered in 4 patients, which was expressed by the normalization of the number of Escherichia coli, lactic acid bacteria. In 12 (32%) patients there was no change.

In 3 out of 8 children with exacerbation of allergic dermatosis, allergic manifestations subsided without additional prescription of sorbents and (or) antihistamines.

Side effects in the form of increased stools up to 2-3 times a day were observed in 4 patients, a tendency to flatulence in 2 (children under one year old). In 6 children with initial complaints of a tendency to constipation during treatment, daily bowel movements were observed.

FINDINGS

Thus, even with the appointment of the minimum dosage of Lactusan syrup in 58% cases, a positive effect is observed. As the dose increases, better results can be expected.

The advantages of the drug also include the possibility of using a relatively small course, the absence of negative organoleptic properties.

It is also relevant to prescribe the drug to patients with a tendency to constipation.

Lactusan in the treatment of patients with parenteral viral hepatitis

For the treatment of severe (fulminant) forms of viral hepatitis, a synthetic disaccharide of milk sugar, lactulose, is recommended, which has a protective effect on the liver tissue and intestinal mucosa (S.N. Sorinson, 1997, E.G. Shcherbakova, 1998).

Synthesized by domestic biotechnologists, the drug Lactusan is a lactulose syrup. Its import counterpart is Normase (Italy).

PURPOSE OF THE STUDY

The purpose of the work was to study the feasibility of using lactulose preparations for the treatment of acute parenteral viral hepatitis (CH) of moderate severity and a comparative assessment of their action.

MATERIALS AND METHODS

Treatment was carried out in 24 patients: 11 people received Lactusan, 13 - Normase according to the scheme: on day 1 - tsp. 1 time, on day 2 - 1 tsp. 2 times, on day 3 - 1 tsp. 3 times, from 4 to 14 days - 1 tbsp. 3 times a day after meals.

The groups of patients were comparable in terms of sex, age, etiology of CH, duration of hospitalization, and the presence of concomitant diseases. The indication for treatment was the lack of effect from the usual basic therapy for VH (in 18 people) or exacerbation of diseases (in 6 people). The patients were clinically monitored, and liver function tests and GV markers were studied in dynamics.

RESULTS OF RESEARCH

The results of the therapy showed that the majority of patients (20 people - 83%) improved already in the first 3-4 days, in 3 - on the 6-8th day of treatment. There was a disappearance of feelings of weakness (by 3.4 ± 0.2 days), anorexia (by 3.1 ± 0.1 days), nausea (by 2.9 ± 0.3 days), headache (by 3.2 ± 0.2 day), abdominal pain (by 3.4 ± 0.3).

Jaundice decreased by 4.0 ± 0.5 days, liver — by 5.7 ± 0.8 days of treatment.

Bilirubinemia during the treatment period decreased from 135.5 ± 23.9 to 53.8 ± 15.5 µmol/l (P < 0.01), alanine aminotransferase (ALAT) activity decreased from 15.8 ± 1.8 to 5.5 ± 1.2 mmol/l (p < 0.001). There was a trend towards a decrease in the thymol test (from 9.7 ± 1.2 to 7.4 ± 1.1), the prothrombin level returned to normal. Only in one patient, against the background of a decrease in intoxication, normalization of liver function tests was not determined.

Comparison of improvement indicators in patients treated with Lactusan and Normaze was statistically revealed by the following data.

So, in the treatment of Lactusan, weakness disappeared on 3.4 ± 0.3 days, Normaze on 3.3 ± 0.2 days, anorexia, respectively, on 3.0 ± 0.2 days and 3.3 ± 0.2, headache on 3, 4 ± 0.2 and 3.5 ± 0.5, nausea — by 2.6 ± 0.2 and 3.2 ± 0.5, abdominal pain — by 3.4 ± 0.6 and 3.5 ± 0, Day 4, jaundice decreased by 3.3 ± 0.4 and 4.7 ± 0.7 days, liver size decreased by 6.4 ± 1.5 and 5.05 ± 0.7 days of treatment. There were no side effects from the use of drugs.

FINDINGS

Thus, the inclusion of parenteral SH with moderate treatment of the lactulose drug Laktusan into the complex pathogenetic therapy is appropriate and clinically justified.